A public inquiry found that clients of the private Helios Wellness Clinic, who paid annual membership fees of up to $10,000, received screenings for colon cancer within weeks, while regular patients with the same cancer risk were waiting up to two years.

Senior executives with the province’s health authority should have conducted a more thorough investigation into queue-jumping allegations at a Calgary clinic when they first landed on their desks, according to an external review released today.

When concerns were raised in March 2012 that some patients at Colon Cancer Screening Centre were getting preferential access to endoscopies, the review found an Alberta Health Services senior vice-president and other top executives who have since departed decided there was insufficient evidence to justify a formal inquiry.

“The reviewers believe that additional investigation was warranted due to the serious and complex nature of the allegation, with a potential direct impact on patient care,” the report said.

Given that the province had launched a judicial inquiry into queue-jumping just a month before, the report by two B.C. experts says “it would seem that this issue should have been addressed in a more systematic and rigorous fashion.”

As the inquiry would later find, clients from the private Helios Wellness Centre, who paid annual membership fees of up to $10,000, were screened at the clinic within weeks while regular patients with the same cancer risk would wait about two years.

The public inquiry report this fall also found that a doctor had approached the clinic’s director, Dr. Alaa Rostom, in March of 2012 with concerns that one gastroenterologist, Dr. Ron Bridges, was giving preferential access to some patients.

Rostom denied it was occurring, but later sent a memo to all CCSC physicians and staff about the centre’s policy on patient access.

When Dr. Francois Belanger, the senior VP and Calgary zone medical director, got that memo, he contacted several physician leaders within the city and had brief communications with the administrative leads for the screening program.

“His investigation seemed to be focused on whether a particular physician had facilitated improper preferential access rather than whether there was a broader issue within the CCSC,” the report said.

Belanger’s “informal assessment, rather than a review” ended after Rostom said there had been issues in the past, but that they had been dealt with and preferential access was no longer occurring.

The decision not to hold a formal inquiry into the allegations was made by Belanger and AHS’ chief executive, Dr. Chris Eagle, and another senior vice-president, Dr. Dave Megran.

Megran was terminated several weeks ago and Eagle resigned his post on Thursday.

Belanger was unavailable to be interviewed Friday, but AHS officials said he is still on the job.

While a clinic study found 78 patients jumped the queue for colonoscopies, the reviewers — Joanne Konnert and Murray Ramsden — found the number was likely higher.

They said they found it difficult to understand how Rostom did not know that queue-jumping was occurring given his involvement in the clinic’s day-to-day operations.

Rostom left CCSC in July for a job outside Alberta.

The reviewers said Debra Pontifex, the clinic’s operations manager who is now on administrative leave, told them she would not have challenged Bridges — even though he was not following the clinic’s booking procedures — because he was such an influential physician.

Bridges, the clinic’s medical director when it first opened in 2008 and now the associate dean of medicine at the University of Calgary, told the reviewers he was not involved operationally with the clinic when the queue-jumping occurred.

But they said minutes of meetings and email documentation at the CCSC led them to conclude otherwise.

“Staff reported to us that this physician was viewed by them to be very powerful and with significant influence,” the review said.

The report said Rostom also sought Bridges’ advice frequently, even consulting him about disciplining another doctor who was late for work.

AHS officials said Friday that Bridges no longer sees patients at CCSC nor is he involved in any way with the clinic’s operations.

Health Minister Fred Horne said he is confident the health authority will address the shortcomings the review found.

“I can’t comment on the conduct of any one practitioner,” Horne said.

“We expect senior leaders in the health system to put quality first and have the appropriate monitoring systems in place.”

AHS declined to answer questions about whether the review has prompted further investigations.

But Liberal health critic Dr. David Swann said the province’s medical watchdog needs to follow up on the findings.

“There’s definitely a role here for the College of Physicians and Surgeons of Alberta,” Swann said.

“Standards and ethical conduct by doctors is their bailiwick.” The review found that Belanger should have notified his administrative counterpart, vice-president and south sector chief operation officer Brenda Huband, of the complaint and involved her in the investigation.

In the future, the report said AHS should also consider calling in its multi-disciplinary investigation co-ordination team to handle similar allegations that are serious, high-risk or complex.

While a May 2013 audit found queue-jumping is no longer happening at the clinic, the reviewers found clerical staff also did not feel they could approach management if preferential access was happening. Those with concerns were also unaware of the AHS whistleblower protection policies.

“It’s been a difficult circumstance,” Huband said.

“We will ensure that the staff know what the processes are in place to ensure that their concerns are heard.”

High-priority patients are now being seen at CCSC in about two weeks, the shortest wait in the clinic’s five-year history.

But continued inefficiencies mean average risk patients are still waiting up to 24 months to be screened.

For example, on one day the reviewers were in the clinic, only five of the 19 patients booked for pre-screening sessions bothered to show up.

“Examples were given during interviews of situations where patients cancelled their appointments numerous times,” the review said.

“This adversely affects other patients who have spent a long time waiting.”

Huband said AHS is working to implement all the changes recommended by the review, including clarifying the roles of the clinic’s medical director and administrator.

“We took this very, very seriously and it was Alberta Health Services who ordered this review,” she said.

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